Surgical operating time is the total duration of a surgical procedure: it begins when the surgeons perform the first skin incision and ends when they suture the skin. Reducing operating time is crucial for optimizing patient outcomes.
Prolonged operating times lead to increased complications, reoperations, and surgical site infections. Time in the operating room is also precious price-wise; a single minute of surgery time in California has been estimated to cost $36–37.
This article explores smart and effective ways of reducing operating time without compromising surgical performance.
Preoperative planning
Preoperative planning is the preparation process before a surgical procedure. It is based on hospital-specific standards that involve evaluating the patient’s health status through physical examination, blood work, imaging, and risk assessment tests; obtaining informed consent; planning and scheduling the surgery; and assigning surgical team member tasks.
A thorough preoperative plan helps surgeons visualize the procedure and understand patient characteristics. It also prepares the surgical team for challenges that may arise during the procedure, boosting work performance while reducing operating time.
A study analyzing more than 200,000 knee replacement surgeries in the US found that preoperative planning shortens the operating time on average from 112 to 93 minutes. This is crucial, considering that knee replacement surgeries lasting longer than 100 minutes are associated with a much greater risk of infections. The study added that preoperative planning also improves patient outcomes and reduces healthcare costs.
Team communication and coordination
Proper team communication and coordination in the operating room represent the harmonious and cooperative work atmosphere between surgical team members. A well-coordinated surgical team can anticipate challenges, minimize errors, streamline workflow throughout the procedure, and optimize operating time. Studies have evaluated various concepts and practices to ensure adequate team coordination and communication.
A study in the Journal of the American Medical Association (JAMA) assessed the benefits of surgical team briefings and time-outs for teamwork. Team briefings and time-outs involve three-way communication between the surgeons, anesthesiologists, and nurses before surgery. During these practices, the team members introduce themselves and confirm patient identity and procedure details.
An effective briefing, according to the JAMA study, can reduce surgeon-reported delays by 80% and unexpected delays by 31%. On top of this, a briefing takes as little as two minutes to complete.
Maintaining a surgical team of members who know one another can also speed up surgeries. An Annals of Surgery review suggests that team familiarity significantly reduces operating time and improves surgeons’ experiences.
Protocols and standardized operating procedures
Protocols and standardized operating procedures (SOPs) in surgery are a set of regulated instructions for performing surgery. They provide the surgical team with a systematic guide for reducing variability in practice and increasing efficiency, thus minimizing delays. Standardization also shortens anesthetic procedures and turnover time (the time to switch between surgical patients).
The Enhanced Recovery After Surgery (ERAS) protocols provide an example of surgical protocols designed to optimize patient care before, during, and after elective surgeries. Standardized operating procedures and protocols like ERAS are regularly updated to include up-to-date techniques and technologies. They’re also flexible enough to account for patient-specific characteristics and surgeon preferences.
Optimizing surgical instruments
Ergonomic instruments can improve surgeon comfort, reduce fatigue, and enhance precision. Cutting instruments, such as scalpels, or those intended for holding, such as retractors and forceps, are associated with physical strain for surgeons (though light and ergonomic solutions are becoming available). Thus, creating comfortable instrument designs is increasingly important.
Optimized maintenance and sterilization processes also ensure the long-term functionality of instruments. A surgery-specific set of instruments must be available before surgery to prevent unnecessary delays.
Alternatively, surgeons and hospitals may choose disposable instruments—instruments usually made of plastic polymers that are used once and discarded. Evidence suggests that disposable instruments may cut operating times, as they do not need to be reprocessed. Conversely, patient-specific instruments have not proven as effective in this respect.
Researchers also recommend optimizing instrument trays by removing redundant instruments. While it might sound trivial, this practice has been shown to reduce the time it takes to assemble instruments and set up the operating room by up to 66% and 37%, respectively.
Time management strategies
Surgery time management strategies are measures or methodologies that maximize the time spent in the operating room. Specific methodologies, including Six Sigma, Total Quality Management, and Plan-Do-Study-Act, save surgery time and costs while preserving efficiency.
“Parallel processing,” in which the surgical team performs surgical tasks simultaneously rather than sequentially, is a promising strategy. Parallel processing involves carrying out the induction phase of anesthesia while the surgical site is being prepared. It also foresees setting up surgical equipment for the next case while the current one is being completed.
Another time-friendly strategy concerns optimizing operative scheduling. Evidence suggests that scheduling cases of the same procedure one after the other is a more time-efficient alternative to mixing up the schedule.
The concept of “overlapping surgeries,” in which senior surgeons move from one operating room to the other to save time, has also been explored. This strategy might be beneficial for surgeries lasting less than two hours. However, it raises ethical and safety concerns.
Patient positioning
Positioning the patient before surgery means correctly aligning the patient’s head, body, and limbs to the type of surgery. Patient positioning is regulated by guidelines that vary depending on the procedure. Abdominal surgery, for example, calls for a supine (face-up) patient position. Conversely, spine surgeries require that patients be placed in a prone (face-down) or lateral (sideways) position.
An optimal patient position reduces the need for intraoperative adjustments, improving surgical time and access. This practice also protects the patient from skin and soft tissue injuries, such as pressure ulcers, as well as dangerous anesthetic complications, such as accidental extubations (removals of respiratory tubes).
Cushions, pads, and other pressure-reducing devices are often used to help “lock” the patient into place.
The role of anesthesia
Anesthesia induction, maintenance, and emergence significantly impact operating time. Anesthesiologists and anesthetist nurses are responsible for:
- Implementing time-efficient protocols and guidelines
- Assessing the patient preoperatively using risk scores
- Deciding what type of anesthesia is surgery-appropriate
- Communicating with the surgeons at all stages of surgery
All these tasks help prevent time-consuming complications that may occur during surgery due to prolonged anesthesia.
Choosing the most adequate anesthesia modality is especially important. A study found that total intravenous anesthesia (TIVA) with propofol shortens operating time compared with general anesthesia in lengthy lumbar surgeries. This approach holds even for delicate procedures, such as brain and eye surgeries.
Medical team training
Medical team training (MTT) involves educational efforts to educate surgical team members on various aspects of surgical care. MTT is a continuous process; it provides intensive teaching modules that improve patient outcomes, surgical performance, and operating time. Teaching strategies can be simulation-based or classroom-based.
Studies analyzing the implementation of medical team training strategies have shown that this practice significantly reduces operating delays and case scores. MTT fosters leadership, motivation, and problem-solving in the operating room. MTT also promotes cooperation between team members: a critical factor in improving surgical efficiency.
Minimally invasive surgery techniques
Minimally invasive surgery refers to procedures performed through tiny incisions instead of large openings. Although it is not suitable for all procedures, it can reduce operative times compared to traditional open surgeries when applicable.
Minimally invasive surgery techniques include the following time-saving advantages:
- Smaller, faster-to-open-and-close incisions
- Reduced tissue manipulation
- Enhanced visualization of the surgical area
- Specialized instruments and innovative technologies
Common procedures where minimally invasive surgery has been proven to save time are appendectomy (appendix removal surgery) and hysterectomy (uterus removal surgery). It should be noted, however, that minimally invasive procedures may take longer until the surgical team becomes proficient with the technique and equipment.
